Haven't been on these forums in ages, but the latest comic brought me back.

I am a health actuary on individual (and commercial), and this very issue is something very close to my heart. I have actually done an analysis on this in the recent past. The subsidies Zach is referring to are the APTC, advance premium tax credit or something along those lines. What these subsidies do is basically say, if you make below 400% of the poverty line, you have your health insurance premium (for the second lowest cost silver plan) capped, at just under 10% for the people just making the cut, lower percent as you approach poverty. Anything above this, the federal government takes on.

The federal poverty level in 2018 is 12060 plus 4180 per dependent, so for a family of 5 the 400% cutoff is $115120 per year, and they would pay up to $11155 for the second lowest cost "silver" plan.

So now a bit more. The premium you pay is based on the sum of the age factors for the adults and the first 3 kids below 20, times the base rate. So if the family is a couple both age 46 (1.5 each) and the base rate is 200, the premium is 600 a month or 7200 a year. The age factors were fixed slightly for kids under 20, increasing them. Age factors increase with age to a 3 to 1 ratio of 64+ to a 21 year old, and there is talk of changing to a 5 to 1 since even with this steep factor the young still subsidize the old. But anyway.

So now let's take the doomsday scenario. Family of 5, parents age 64 and 64, kids all 17, so it's not like they can be kicked out. Their total factor is 8.655. If the base rate is our 200 a month, this family making 115120 should be paying 20772. But they are only paying 11155. Until they get a dollar raise, and now their health insurance goes up by 9617. And that's at the 200 base rate, which is comically low. In Albemarle county, it appears to be about 790. What does that mean? Well, in our doomsday scenario, plugging in 790 now gives 82049, or a spike of seventy thousand going from subsidized to unsubsidized. Oh and this doesn't include the extra factor for smokers, nor does it include the deductible or MOOP. That's like, everything they earn, tax deductions or not. To make 70k extra, this family is looking at requiring a raise from, ballparking here, somewhere around 110k-ish extra income assuming self employed just to break even.

I'm curious, as you're mentioning all these facts and figures--where do they come from? Who is it that determines healthcare base costs and the like? Is the government? Health care providers? Someone else?

Honestly, it seems to me like someone, somewhere, is profiting WAY outside of a normal margin for the health of the nation--which seems entirely unhealthy for the country as a whole.

I have been told that the reason our healthcare costs are so high is because that's what people are willing to pay, but I've never actually seen a breakdown of how, say, a stay in a hospital actually breaks down. Or how much it costs to own and run an MRI machine. Or ...why pills cost as much as they do.

So yes. While I agree that something is broken in our healthcare system, I don't think just focusing on one aspect of the system is the best way to fix it. We need a comprehensive healthcare overhaul. We need people, normal people, understanding why everything costs the cost it does. And we need to start treating people that profit by preying on the needs of the public as a problem and a detriment to the country's well-being and health. Otherwise we're just treating the symptoms, and as our health professionals will tell us, treating the symptoms without addressing the underlying causes isn't going to provide a lasting and real change.

Anyone know where we can get this information? Or how healthcare costs are determined? That's something that -should- be available...somewhere.

Could be worse - the entire state could lose all of their individual health providers (see: https://www.usnews.com/news/best-states ... e-solution). Yes, I understand these are only ACA Exchange providers - but if you wanted to secure individual coverage, that was your best bet (and only bet to take advantage of the available subsidies - if you qualified).

No, this isn't a measuring contest of "whose state is in bigger trouble" .. it is an admission that there is support in the Midwest for some sort of policy change.

Fed poverty level is set by the government, as is the APTC rules, and the age factors. The age factors are wrong; they overcharge young people so they can under charge old people. The age factors also stopped being age-sex factors some time back in 2012, i think, so young women and old men underpay and old women and young men overpay. You might think this evens out in the end, but if people overpay, they leave. So what happens is the death spiral of the market; prices get jacked up to cover costs, increasingly less healthy leave, until absolutely no one has coverage. The APTC and individual mandate are supposed to stop this, but the mandate hasn't really been enforced, and the APTC stops at 400% so Optima is pricing under the assumption that the healthier members aren't getting coverage. Then there's all the fraud and so forth that people play games with, but not getting into that.

Also not getting into tobacco and area factors.

However, there's a lining here. Let's say optima is truly not pricing right. If their loss ratios, averaged over 3 years, are too low they have to pay back to members. So they dont get to keep all of that money.

As for who is profiting, to start with there are the pharmaceuticals. The research and development is mostly paid for by the public, then sold at a discount to the company, who then fleece the public. Worse, it's companies like Merck who aren t even American. Corruption of us government, what's That? Look at humira for another example of problems. It's been generic for a year or so, or biosimilar or whatever, but there's no us alternative because it's stuck in the courts regarding the delivery method; 19th century tech, but combined with the drug is somehow new. Meantime, it costs $50k per year, for rhuemetoid arthritis which is fairly common, while in India the same drug is 300 a year. Don't get me started on Gilead.

Come live in Saskatoon, Saskatchewan, Canadia. We have cheap small business tax rates and we don't have personal health care premiums. Healthcare services are excellent to comparable. Individual, spousal and child tax breaks are abundant.

Provincial taxes are 11% on the first $45,225.00 of earnings, 13% on the next $83,989.00, and 15% on anything over that. Federal taxes are more complicated, but that's what happens when the Liberals govern. Their rates are 15% on the first $45,916, 20.5% on the next $45,915, 26% on the next $50,522, 29% on the next $60,447, and 33% on anything over $202,800.

There is no municipal income tax, but rather a property tax to cover education and municipal government. Property taxes aren't that bad. I think I pay ~$1,500.00 a year for my three bedroom townhouse.

Plus, if you are making money in USD, converting your assets to CAD at this time is going to work out real well for you.

Think about it. We have a beautiful university campus in the heart of the city with all kinds of science/research stuff (my friend works at the synchrotron) and the campus itself is gorgeous. Your beard will protect you from the cold Canadian winters and will give you hipster camouflage when you go out. Plus, Trump is not the president of Canadia, we have a prime minister named Justin Bieber, I think.

In your brainstorming session, did you guys consider forming your own de facto insurance company, by pooling your funds and paying out for at least major expenses? I have done exactly 0 legwork (besides looking up the population of Charlottesville, apparently about 46,000) into researching its feasibility, but it might be an option to consider. I imagine it would be a decent bit of work, but desperate times, you know? Maybe you could muster up a subcouncil of folks to look into it. It's just a thought, but it might beat waiting on a political fix.

You guys should check out Dinesh D'Souza and his take on the US healthcare system. There are clips of it all over youtube. Or check out Stephan Molyneux. Or that video by PragerU about about why healthcare is so expensive. There's plenty of other people too, I remember, screaming about the ACA for years about how healthcare premiums would rise super drastically for the average American citizen for various reasons.

I did check it out in the past but I'll be honest with you I don't remember all the reasons at the moment. The reasons I do remember are that there aren't actually enough hospitals/doctors to cover the need of all the people in the US even if we did get universal healthcare, that we get the highest/best technology medically first and as a result get the highest costs first, that there are too many taxes/ government regulations driving out competition so that the few insurance companies who do cover your area have a monopoly and can therefore charge as much as they want, that hospital administrative fees are too high. But yeah use your own judgement and research it. In my opinion, politically, we need to get to a more free market system and have less regulations, allow competition on the market and that will lower the costs. But it's not a quick fix for Charlottesville. They should have been more worried about this 7 years ago, looked into the ACA, and done their research then, but I don't entirely blame them because the information available was extremely censored. Just trying to share a video link with Dinesh D'Souza's videos would get me a warning from my ISP about 'piracy link sharing' or something like that XD

And can I just say that I'm pretty frustrated that Zach decided after all these years to do a serious, breaking-the-fourth-wall political comic because of the health care challenges faced by *small business owners* rather than when Republicans threatened twenty million people's health insurance a month ago? Like, yes, it's crappy that we have to deal with private, profit-seeking insurance and a system largely based on employer group insurance instead of having single-payer like a civilized country, but it's mostly crappy because it absolute devastates the poor and the sick, and it's really disappointing that intelligent people care so much more when it happens to their in-group than when it happens to the disadvantaged. Really disappointing.

While I don't know the specific legislation and rules of where you live, nor if the possibility has been raised by people in said meeting but:

Couldn't essentially the people in the meeting get group insurance together? That is, form some kind of association, let's call it a club, union, or even a guild, that you'd be members and then hire group insurance through it. Now, there'd be some work in organizing it, administrating it and making sure no one decides to be a free rider, but given the circumstances it shouldn't be impossible either.

the problem is sadly not just your healthcare insurances. Just compare the cost of a banal operation in a U.S. hospital vs. a hospital in any of the western Europe countries. The difference is staggering, by even TWO orders of magnitude. A night in a hospital in the US is averaging $2.000. In europe, it's less than a hundred dollars on average, and most of the cost will be paid by the government, not the person in need of the care.The cost of a bag of saline solution ? hundred times more than what it costs to make it.somewhere in the U.S. health system, at several levels, there were collusions among most of the big players to raise margins by an obscene amount, and some people get filthy rich overpricing healthcare items and services. It does not seem to be the doctors, whose income seems in the same ballpark as european doctors. Nowhere in europe will you go bankrupt because you had to stay a month in a hospital. a MONTH. you may have to pay a bit, but most of it is paid by the national healthcare systems, who tax workers and companies appropriately (read : depending on salary, situation, etc. People without income do not pay those taxes, people with low income pay very low, people with good to big income pay more but it's still easily affordable). All this is regulated, so nobody can abuse a monopoly situation to inflate prices like it happened in the U.S.A.

Regulate these prices if you want to save your healthcare system. Don't let people ask for a thousand bucks for an item that's worth a couple bucks. I know it goes against the almighty capitalism, but it really seems necessary.

The cost of a hospital stay is calculated differently in Europe and the US, and depends on whether the hospital adds fixed or variable costs. For example, a hospital has 100 beds, fixed costs of $200k, and a surgery ward. Each surgery has variable costs of $10k, and each bed has variable costs of $200/night. Every day there are 100 patients and 10 surgeries, for a total cost of $320k. Do you say that the surgeries are all $10k each, and the beds are $2200 a night, all surgeries are $30k and the beds $200, or somewhere in between?

But the bigger picture is that the US and the EU have vastly different legal systems. Now, the number of malpractice suits is exaggerated, but their effects on medicine are not. Somewhere in the ballpark of 1/3 of medical care is CYA medicine, tests and such that have little benefit beyond protecting the doctor from that one lawsuit where the person really does have some exotic disease. This means that literally 1/3 of that $10k/yr medical costs are waste. Well, not exactly, since the excessive testing does catch those rare diseases, but what undoes this is that testing is only relatively safe; every mammogram has a 1 in 50,000 chance of giving fatal cancer, and CT scans are even worse. At least mammograms catch more disease than they cause, but chest CT's are way overused.

Last edited by CorruptUser on Sat Dec 09, 2017 4:36 am, edited 1 time in total.

I am a healthcare supplier and professor. This kind of health coverage cost increase due to implementing the ACA was predicted years before it was put into law. Here we are and everyone is confused. I don't understand peoples' surprise. Instead of blindly voting with a party you've selected, it is the population's duty to fully understand the policies and bills our government leaders put forth. This is why so many people were against the ACA.

Here is a quote printed by the BBC: World Health Analyst OVER TWO YEARS AGO: "Premiums are to rise by an average of 25% in 2017. This increase was predicted at the start of the law, and government subsides to help pay for insurance will also increase. But those who should be covered by the Medicaid expansion aren't eligible for those subsidies."